Evaluation of unipolar transfer of the latissimus dorsi to flexor antebrachii in patients with arthrogryposis

Abstract

Objective To evaluate active elbow flexion restored with latissimus dorsi (LD) transfer in patients with arthrogryposis and determine the correlation with the level of segmental injury to the spinal cord. Material and methods Active elbow flexion was restored in 30 patients with arthrogryposis (44 upper limbs) using unipolar LD transfer performed between 2011 and 2018 at the Turner Scientific and Research Institute for Children’s Orthopaedics. The patients’ age at the time of surgery ranged from 1 year to 10 years with the mean age of 3.98 ± 2.35 years. Clinical and neurological assessment was performed for the patients. Statistical data analysis was produced. Results The patients were subdivided into three groups with regard to the level of segmental injury to the spinal cord including С6–С7 (n=8, 29.6 %, 13 limbs), С5–С7 (n=17, 54.5 %, 24 limbs) and С6 (n=5, 15.9 %, 7 limbs) levels. The patients were followed from 1 year to 7 years (3.2 ± 1.9). Postoperative passive and active elbow flexion was 100° ± 7.0° (min 80°, max 110°) and 90.5° ± 14.7° (min 40°, max 110°), respectively. Extension deficit of the elbow increased by 12.8° ± 4.8° (min 10°, max 20°) in 18 (51%) cases but made no impact on activities of daily living. The results of 20 patients (55.6 %) were rated good, 12 (33.3 %) were satisfied and 4 (11.1 %) had poor results. No correlation could be found between postoperative active flexion, extension deficit of the elbow and the level of segmental injury to the spinal cord in patients with involved levels of C6–C7 and C5–C7. Conclusions The LD can be regarded as the choice flap for restoration of active elbow flexion in patients with arthrogryposis and segmental involvement at С6, С6–С7, C5–C7 levels with baseline donor muscle strength grading 4 and over and passive elbow flexion of at least 90°.